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To examine retinal vascular caliber, an indicator of early microvascular disease and depression in patients with Type 2 diabetes.We conducted a clinic-based study, comparing participants with Type 2 diabetes with major depression (n = 43), without depression (n = 49), and healthy controls without diabetes or depression (n = 54). Retinal vascular caliber was measured from digital photographs. Depression status was determined, using standardized clinical assessment.After adjusting for age and gender, participants with diabetes and depression had larger arteriolar and venular calibers (147.7 μm for arteriolar and 215.7 μm for venular calibers) than participants with diabetes but without depression (143.3 μm and 213.9 μm) and healthy controls (135.8 μm and 202.5 μm, p for trend = .002 for arteriolar and p = .02 for venular caliber). In multivariate models adjusting for duration of diabetes, systolic blood pressure, cigarette smoking, serum glucose, Cerebrovascular Risk Factor Scale, Cumulative Illness Rating Scale, and retinopathy levels, this relationship remained significant for retinal arterioles (p = .02) but not for retinal venules (p = .10).These data show that patients with Type 2 diabetes with major depression have wider retinal arterioles, supporting the concept that depression is associated with early microvascular changes in Type 2 diabetes.